Is second-line systemic chemotherapy beneficial in patients with non-small cell lung cancer (NSCLC)? A multicenter data evaluation by the Anatolian Society of Medical Oncology.

Patients with advanced non-small cell lung cancer (NSCLC) generally require second-line treatment although their prognosis is poor. In this multicenter study, we aimed to detect the characteristics related to patients and disease that can predict the response to second-line treatments in advanced NSCLC. Data of 904 patients who have progressed after receiving first-line platinum-based chemotherapy in 11 centers with the diagnosis of stage IIIB and IV NSCLC and who were evaluated for second-line treatment were retrospectively analyzed. The role of different factors in determining the benefit of second-line treatment was analyzed. Median age of patients was 57 years (range 19-86). Docetaxel was the most commonly used (20.9 %, n = 189) single agent, while gemcitabine-platinum was the most commonly used (6.7 %, n = 61) combination chemotherapy regimen in second-line setting. According to survival analysis, median progression-free survival after first-line treatment (PFS2) was 3.5 months (standard error (SE) 0.2; 95 % confidence interval (CI), 3.2-3.9), median overall survival (OS) was 6.7 months (SE 0.3; 95 % CI, 6.0-7.3). In multivariate analysis, independent factors affecting PFS2 were found to be hemoglobin (Hb) level over 12 g/dl and treatment-free interval (TFI) longer than 3 months (p = 0.006 and 0.003, respectively). Similarly, in OS analysis, Hb level over 12 g/dl and time elapsed after the first-line treatment that is longer than 3 months were found to be independent prognostic factors (p = 0.0001 and 0.045, respectively). In light of these findings, determining and using the parameters for which the treatment will be beneficial prior to second-line treatment can increase success rate.

Sunitinib-induced severe hypoglycemia in a diabetic patient.

INTRODUCTION: Sunitinib is an oral inhibitor of tyrosine kinase that was used for the treatment of mRCC. The general side effects are fatigue, asthenia, diarrhea, mucositis, nausea, vomiting, skin changes, hypertension, hypothyroidism and hematologic side effects. In addition, sunitinib-induced hypoglycemia has also been reported. There are limited number of case reports related to sunitinib-induced hypoglycemia. CASE PRESENTATION: In this case report, we have presented a patient with type 2 diabetes mellitus (DM) with emerging severe hypoglycemia after sunitinib treatment. It was shown that blood glucose levels were normalized two weeks after the interruption of sunitinib. CONCLUSION: Although the underlying mechanism of sunitinib-induced hypoglycemia is not completely understood, sunitinib can be regarded to have an antidiabetic effect. In the literature, there are some reports about sunitinib/other TKI induced hypoglycemia; however, life threatening hypoglycemia is rare. There is no case report of severe hypoglycemia due to imatinib; however, there are two case reports with severe hypoglycemia due to sunitinib treatment. Symptomatic hypoglycemic episodes due to sunitinib may lead to hospital admission. Diabetic patients may develop severe hypoglycaemia and it should be kept in mind that the discontinuation of antihyperglycemic treatment may be required. Therefore, blood glucose levels should be closely monitored in diabetic patients with mRCC during sunitinib therapy.

Prognostic Factors in Operated Stage IIIC, Pathological N3a Breast Cancer Patients.

BACKGROUND: The aim of this retrospective study was to evaluate the prognostic factors in patients operated for stage IIIC breast carcinoma who had > 10 positive axillary lymph nodes (pN3a). PATIENTS AND METHODS: The medical records of 302 operated N3a breast cancer patients without distant metastasis followed up in 2 medical oncology clinics in Ankara between January 1998 and June 2013 were evaluated retrospectively. RESULTS: The median age was 50 (21-83) years. The median follow-up time was 43 (5-191) months. The patients were divided into 4 subgroups according to hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. There were 151 (50.0%) patients in the HR+/HER2- group, 80 (26.5%) patients in the HR+/HER2+ group, 42 (13.9%) patients in the HR-/HER2+ group, and 29 (9.6%) patients in the triple negative (TN) group. At the time of analysis, 155 (51.3%) patients had recurrent disease and 117 (38.7%) patients had died. The median disease-free survival (DFS) and overall survival (OS) times were 46.0 and 78.0 months, respectively. Both the DFS and OS in the HR+/HER2- group were longer than in the other groups (log-rank p = 0.034 and p = 0.016, respectively). Menopausal status, progesterone receptor (PgR) status, and lymph node ratio (LNR; defined as the number of positive lymph nodes compared to the total number of removed lymph nodes) were found to be independent prognostic factors (p = 0.019, p = 0.001, and p = 0.012, respectively). CONCLUSION: Menopausal status, PgR status, and LNR were independent prognostic factors in operated N3a breast cancer patients, who are underrepresented in breast cancer trials.

Metaplastic breast carcinoma: case series and review of the literature.

Metaplastic breast carcinoma (MpBC) is a rare disease entity, accounting for less than 1% of all breast carcinomas. Furthermore, it is a heterogenous disease with different subgroups, including malignant epithelial (carcinoma) and stromal (sarcoma) features. Here we evaluated, retrospectively, 14 female MpBC patients admitted to Ankara Oncology Training and Research Hospital between 2005 and 2011. Median age was 45.5 (range:16.0-76.0) and tumor size 57.5 mm (range: 20.0-80.0 mm). Histopathological subtypes were as follows: 5 carcinosarcoma, 5 squamous and 4 adenosquamous carcinoma. All but one with upfront lung metastasis, had their primary breast tumor operated. Axillary lymph nodes were involved in 64.3%. The most common sites of metastasis were lungs and brain. Chemotherapy including antracycline, taxane and even platinium was planned for adjuvant, neoadjuvant and palliative purposes in 9, 3 and 1 patient, respectively. Median cycles of chemotherapy was 6 (range:4-8). Median follow-up of the patients was 52 months (95%CI 10.4-93.6 month). Median 3 year progression free survival (PFS) and overall survival (OS) in this patients cohort were 33% and 56%, respectively. In conclusion, MpBC is a rare and orphan disease without standardized treatment approaches and the prognosis is poor so that larger studies to investigate different treatment schedules are urgently needed.